It’s a subject we find hard to talk about, even though it kills more people in America than guns or cars and claims more lives than murder or suicide.
I’m talking about drug overdoses, taking close to 44,000 lives a year. These often follow a pipeline from prescription painkillers to heroin — a result, in part, of reckless marketing by pharmaceutical companies and overprescribing by doctors. These days, heroin is out of control, with deaths nearly tripling in three years.
To understand the lure of heroin and how to combat it, I came to Baltimore to talk to some experts: addicts.
“A guy was like, ‘try this, it’ll make you feel good,’ ” recalled Ricky Morris, who has struggled for years with heroin. “And it did make me feel good. It makes you feel superhuman. You can have sex all night long.”
Yet, after a while, Morris was waking up sick each day and needed heroin simply to feel better. To finance his habit, Morris says, he sold drugs and robbed people: “I started becoming the people I despised.”
Even when he overdosed and nearly died, he continued. After watching his brother overdose and die, Morris was shaken and vowed he wouldn’t take heroin on the day of the funeral out of respect. But the next morning he was so sick that he promptly began searching for a hit.
Now Morris is on methadone, a drug that replaces heroin, and with it he has avoided heroin for four years. But, he adds, it’s a constant struggle: “I’m still trying to take it one day at a time.”
Every year I hold a “win-a-trip” contest to take a university student with me on a reporting trip to examine problems in the developing world. This fall I’ll be traveling with this year’s winner, Austin Meyer of Stanford University, to India and Nepal, but I thought we should first look at social problems at home. So we’re here in Baltimore, talking to addicts.
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Baltimore is aggressively trying to reduce heroin deaths through an outreach program overseen by its health commissioner, Dr. Leana Wen. And as it happens, Dr. Wen was my win-a-trip winner in 2007. We traveled to Congo, Burundi and Rwanda.
“Heroin is actually the underlying problem behind so many issues in Baltimore,” Dr. Wen told me. “It’s why people can’t find employment, why people go to jail, why people don’t get educated. People lose their whole families because of heroin.”
Heroin isn’t a new challenge. But it seemed under control, and then, beginning in the mid-1990s, pharmaceutical companies began promoting opioids as pain relievers. This aggressive marketing resulted in huge profits for the companies but was sometimes reckless, deceptive and criminal. For instance, top executives of Purdue Pharma, which made OxyContin, pleaded guilty in 2007 to criminal charges for their role in deceptive marketing that downplayed the risk of abuse.
By 2012, health care providers wrote 259 million prescriptions for opioid painkillers — enough for a bottle of pills for every American adult.
Many Americans, often military veterans, get hooked on pills, and then, unable to afford prescription painkillers, turn to heroin as a much cheaper alternative. We talk about personal irresponsibility as a factor in drug abuse, and that’s real; so is corporate irresponsibility.
What do we do now? Unfortunately, some education programs to keep people off drugs haven’t worked well in careful studies. Treatment, using methadone and suboxone, does help and is worth expanding — although that, in turn, means reducing the stigma of addiction so that more people seek medical help.
Some conservative politicians oppose needle exchanges, fearing that they legitimize drug use. But evidence is strong that needle exchanges reduce the spread of H.I.V. and hepatitis, saving lives.
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We can also try harder to save the lives of those who overdose. Pharmaceuticals can also be lifesavers, and a drug called naloxone revives people almost immediately.
“There’s nothing like it in medicine,” says Dr. Wen, who, as an emergency-room physician, has used it on many patients. “It’s a complete antidote that acts immediately.”
Some cities are giving naloxone to police officers so they can save lives when they come across people who have overdosed, and Baltimore is going a step further to get it into the hands of people at particular risk of overdose. It trains jail inmates in using naloxone, and Austin and I also accompanied Baltimore health workers as they gave dancers at strip clubs naloxone and taught them how to administer it.
“This is great to know,” said one exotic dancer, clutching her naloxone after the training session. “I’ll be sure to send the other girls.”
Marcia Lee Taylor, CEO of Partnership for Drug-Free Kids responded to this column with the following letter to the editor entitled Addiction Is Preventable:
But addiction is not only a treatable disease; it is also one that can be prevented.
Prevention is a critical component to turning the tide on heroin and prescription-drug addictions. But we must first insist upon an infrastructure that positions addiction as a public health issue, and gives us a forum for change, rather than a debate around substance abuse shadowed in stigma.
The government safety net we once all relied on has been decimated. Federal prevention programs have been zeroed out, and lessons in drug prevention are no longer covered in many schools.
With prevention programs that have all but disappeared, one place to start is with the family, providing education and resources so parents can feel empowered to talk about drugs, including prescription drugs, with their children.
And families can take action by securing prescription medicines in their homes and safely disposing of unused or expired quantities. But we know the responsibility is not all on them.
The responsibility is on all of us.
For medical providers, it may be greater prescriber education. For others, it is a focus on effective treatment. For pharmaceutical companies, it can be a charge to create abuse-deterrent formulations. All are critical if we are going to work together to prevent addiction.
Take your first step by downloading the Addicaid app for iPhone or Android to join the recovery community today.
[h/t: NYT]